Baroda Rajasthan Kshetriya Gramin Bank

Application for Registration for BRKGB M-connect – Mobile Banking Facility

De-Registration of BRKGB M-Connect
Linking Bank accounts with existing BRKGB M-Connect
De-linking Bank Accounts with existing BRKGB M-Connect
Resetting of mPIN
BRANCH- SOL ID - REGION -
I/We request you to arrange to provide/remove above facility of Mobile Baking as per details below:

NAME OF ACCOUNT HOLDER

(In Block Letters)
MOBILE NUMBER
Where Mobile Banking will work
CUSTOMER ID

PRIMARY ACCOUNT NUMBER

Please give the choice of Account holder,
in case of Joint Account with operating
instructions “Either or Survivor”

COMMUNICATION ADDRESS

City State Pin

Email: Tele. No.

Branch Name Name of the Account Holder Account Number

1
EXISTING ACCOUNTS Self
to be linked in Mobile Banking facility.

2 Self
(Please refer the conditions overleaf)
3
(Please ensure that all stated Self
accounts have the same Customer
ID of the applicant) 4 Self

t I / We confirm to download the Mobile Banking software as directed by the Bank through SMS or through any other mode. I / We confirm
that I / we have read the ‘TERMS & CONDITIONS’ related to Mobile Banking, appearing in Bank’s website www.brkgb.com and in the
reverse of this application and accept the same in full unconditionally.
t I/We undertake to state that I/We will not share my/own application password and/or mpin to any one. The complete security of above
password is my/own responsibility.
t I / We understand that I/We shall be required to initiate GPRS services for availing Mobile Banking facility and hence shall be liable to pay
charges to my / our respective Service Provider as per applicable tariff plan. I / We also understand that Bank would not be responsible /
liable for any such charges levied by the Service Provider.

Date :

Place : Signature of first holder Signature of second holder Signature of third holder

(For Branch/Office use only)

Certified that the signature/s of the account holder/s is/are as per the records and recommended for (a) Registration
(b) De-registration, (c) Linking of accounts, (d) De-linking of accounts (e) Resetting of mPIN

Date of posting in CBS : dd mm yyyy Transaction ID in CBS :

________________________ ________________________
Branch : Officer / Accountant Name : Branch Manager
Date : Name : Name :
Sig. Number : Sig. Number :
 Baroda Rajasthan Kshetriya Gramin Bank

Terms and Conditions:

1. Transactions initiated through Mobile Banking application are irrevocable; Bank shall not entertain any request for revocation of
transaction or stop payment request for transactions initiated through Mobile Banking.
2. Customers shall not use Mobile Banking channel for transfer of funds for illegal activities.
3. Customers shall be responsible for the safe custody and security of the Mobile Banking application downloaded on their mobile
phones to avoid unauthorized usage and should immediately inform Bank for disabling of Mobile Banking services in case of loss or
theft of mobile phone.
4. Customers should NOT share their application passwords and MPIN with anyone including Bank’s staff / associate /representative.
5. Customers shall abide by the limits imposed by Bank on maximum number of transactions and maximum amount permitted through
Mobile Banking. Bank reserves the right to change the number of transactions and amount at any time.
6. Bank shall not be responsible for any loss to customers arising out of usage of Mobile Banking.
7. Bank shall be at liberty to affect any change in Term and Conditions from time to time.
Eligibility

No Type of Account Constitution Mode of operation Eligibility

1 SB Account Single Single Account holder is eligible
2 SB Account Joint E or S As per choice of all account holders. Application to
be signed jointly
3 SB Account Joint Jointly NOT eligible
4 SB Account Minor Single Minor above the age of 15 is eligible
5 NRE Account NOT Eligible
6 Current Account In the name of Single The Account holder is eligible
SELF. Single
7 Current Account In the name of Single The Account holder is eligible
firm - Single
8 Current Account Partnership Any one partner The person authorized to operate. All account
Firm holders will sign the application.
9 Current Account Partnership Jointly operated NOT Eligible
Firm
10 Staff OD A/c Eligible
Linking of accounts (Provided Customer ID of the primary account holder and “to be linked” accounts are same)

No. A/cs to be linked

Primary Account with SB SB (Jt / SB A/c NRE A/c C A/c C A/c C A/c Any
M-Connect (Single) EoS) Jointly Single (Self (Firm & Partner /
&Single) Single) Jointly

1 SB or C A/c holder √ √(with x x √ x x

Consent
Disclaimer
It is the Customer’s responsibility to ensure that the Bank’s mobile banking application is compatible with his/her mobile phone/handset. For whatever damage or
loss, if any, incurred by the Customer due to downloading of the Bank’s Mobile Banking software in his/her mobile phone, he/she shall be solely responsible. Further, the
Customer shall be solely responsible/liable in keeping his/her application password and
MPIN confidential to prevent unauthorized access/use of his/her mobile banking facility by any third party. For any payment effected by the Bank to
a beneficiary based on the information received by the Bank from the Customer’s mobile number registered in the Bank’s record for mobile banking
facility, the Customer shall be solely responsible/liable in any manner whatsoever for any loss, claim, liability as the case may be or incidental
thereto.
Declaration
I/We affirm, confirm and undertake that I/we have read and understood the Terms and Conditions for usage of the BRKGB Mobile Banking services (BRKGB M-
Connect) and agree to them. I/We am/are aware that the usage of BRKGB Mobile-Banking is governed by the terms and conditions which are
available on http://www.brkgb.com/ or any other site specified by Baroda Rajasthan Kshetriya Gramin Bank and I/we have reviewed the contents of
the same. I/We accept and agree that I/we are aware of the contents of the terms and conditions and that all my/our rights and liabilities would be
governed by the said terms and conditions by my/our act of accessing, I/we agree to adhere and comply regulation /practices set by telecom
authority /regulatory/banking authority / Government of India / local / state government.etc., towards mobile operations & associated banking
activities. I/we thereby agree to be subject to and comply with all the provisions of the terms and conditions which are incorporated by reference
herein and deemed to be part of this application form to the same extent as if such provisions had been set forth in full herein. The Customer
agrees that the Bank shall not be held liable and shall be absolved from all liabilities whatsoever, if due to any reason beyond the control of the
Bank, the Bank is unable to receive or execute any of the requests from the Customer or there is loss of information during the process of
transmission or processing. The Customer further agrees that he/ she shall not hold the Bank responsible/ liable for any loss whatsoever incurred to
the Customer due to any failure or delay in transmission of information, if there is any error or inaccuracy of information or any other consequence
arising from any cause beyond the control of the Bank which may include technology failure, mechanical breakdown, power disruption, error in
transmission of information or message to any from the telecommunication equipment of the Customer and the network of any service provider and
the Bank’s system or any breakdown, interruption, suspension or failure of the telecommunication equipment of the Customer or the Bank’s
system”.
To be signed by Accountholders